[Infection in elderly leukemic patients]

Febrile episodes occurring in 29 elderly patients (mean age 75 years) with leukemia, from 1988 to 1993, were reviewed. A febrile episode was defined as a temperature of 38 degrees C or greater for at least 6 hours. The number of febrile episodes was 64. The average was 2.2 febrile episodes per patient. Seventy-two percent of febrile episodes occurred when the patients had neutropenia below 100/microliters, while 16% occurred with neutropenia of 101/microliters to 500/microliters. Causative microorganisms were identified in 48% of total febrile episodes. The most common infectious site was the urinary tract which accounted for 25% of total episodes. Pneumonia and septicemia accounted for 22% of total episodes, respectively. Gram-positive cocci were responsible for 66% of microbiologically documented febrile episodes, while 21% were caused by gram-negative bacilli. Gram-positive cocci, particularly staphylococcus aureus, coagulae-negative staphylococcus and enterococci increased compared with a decade ago in our department. Granulocyte colony-stimulating factor (G-CSF) was used 12 times for infection. No significant difference in fever amelioration was seen between G-CSF and non-G-CFS cases.

Effect of temporary occlusion of the hepatic vein on dual blood in the liver: evaluation with spiral CT

PURPOSE

To evaluate the contribution of hepatic veins to the dual blood supply in the liver under temporary hepatic venous occlusion.

MATERIALS AND METHODS

Selected hepatic veins in 23 patients with liver tumors were temporarily occluded with a balloon catheter. Computed tomography (CT) arteriography, CT during arterial portography (CTAP), or both were performed with a spiral technique with and without temporary occlusion of a hepatic vein.

RESULTS

After hepatic vein occlusion, a well-demarcated, wedge-shaped area of hypoattenuation was seen at CTAP and/or hyperattenuation was seen at CT arteriography in the following regions: left lobe (left hepatic vein), ventral part of the anterior segment and the medial segment except for the ventromedial part (middle hepatic vein), dorsal part of the anterior segment and the ventral part of the posterior segment (right hepatic vein), and dorsocaudal part of the right lobe (inferior right hepatic veins).

CONCLUSION

After hepatic venous occlusion, the portal veins become draining veins and the occluded area is supplied with arterial blood alone.

Detection of anti-hepatitis C virus using chemiluminescence

To determine if chemiluminescence can be used in an enzyme immunoassay (EIA) format to test for hepatitis C virus (HCV) antibody and to compare sensitivity and specificity of chemiluminescence to a licensed anti-HCV EIA method, random volunteer donor samples were evaluated. One thousand and seventy-four random volunteer donor samples were collected during a 2-week period. Two aliquots of each sample were tested for anti-HCV. One aliquot was tested using a licensed anti-HCV 2.0 EIA test. The second aliquot was tested using the research anti-HCV chemiluminescence assay. Confirmatory testing was done using Recombinant Immuno Blot Assay (RIBA) 2.0 HCV and HCV RNA. Of the 1074 samples, eight were found to be reactive for anti-HCV. Seven were positive by the anti-HCV 2.0 EIA and the chemiluminescence system. The eighth sample was chemiluminescence reactive, but EIA negative; when tested by an unlicensed EIA 3.0 HCV test, RIBA 3.0 HCV test and an HCV-RNA assay, the sample was still negative. The same sample was also tested by RIBA 2.0 HCV and showed a reactive band to SOD. The chemiluminescence assay has a 100% sensitivity and 99.9% specificity compared to EIA and can be used as an alternative to EIA for detecting antibodies to HCV.

Production of term offspring by in vitro fertilization using old mouse spermatozoa

We successfully produced offspring of old male BDF1 mice using in vitro fertilization. Although 7 old male mice (33 months of age) were infertile and revealed frequent degeneration in the seminiferous epithelia, 4 of them had spermatozoa in the caudae epididymides. The IVF rate of their sperm with eggs from young ICR mice was very high (82.0%). The production rate of offspring was also satisfactory (61.6%). The present study indicates that the IVF method is useful for producing offspring of aged male mice.

Congenital ossification of the stapedius tendon: diagnosis with CT

PURPOSE

To describe the features of congenital ossification of the stapedius tendon at thin-section computed tomography (CT).

MATERIALS AND METHODS

Thin-section CT scans, clinical records, and surgical findings were retrospectively evaluated in nine ears of five patients with surgically proved congenital ossification of the stapedius tendon. Thin-section CT scans of 50 control ears were also reviewed.

RESULTS

On thin-section CT scans, a linear area of soft-tissue attenuation was demonstrated between the monopod stapes and the pyramidal eminence (nine ears), as well as thickening of the stapes footplate (two ears). In the 50 control ears, the normal stapes tendon was not clearly seen on thin-section CT scans.

CONCLUSION

At CT, a linear area of soft-tissue attenuation that extends from the pyramidal eminence to the monopod stapes is suggestive of congenital ossification of the stapedius tendon or a bony bar adjacent to it.

[Perceived quality of life and social factors in elderly hypertensive patients]

We conducted a cross-sectional study of elderly outpatients with hypertension to examine the relationship between quality of life (QOL) scores and social background factors. The subjects consisted of 516 outpatients (267 females), age of 60 or over, at nine clinics of major hospitals which participated in the National Cardiovascular Center Research Project. The perceived QOL was evaluated by the QOL scale originally based on Japanese patients with cardiovascular diseases. The scale consisted of the following 5 subscales; difficulty due to disease, psychological stability, independence, satisfaction in daily living and vitality. The background factors included family structure, socioeconomic factors and work status, and physical activity of daily living (ADL). After adjusting for age, sex, administered drugs and complicating conditions such as ischemic heart disease and/or apoplexy, a significant odds ratio of a low score of difficulty due to disease, psychological stability, satisfaction in daily living and vitality was found in the impaired physical ADL group with low socioeconomic class, and a significant odds ratio of low score of independence were found in the impaired physical ADL group who had lost jobs due to illness and had no children.

Gianturco stent placement in malignant caval obstruction: analysis of factors for predicting the outcome

PURPOSE

To determine the factors that may be used to predict outcome of stent placement in patients with malignancies obstructing the superior or inferior vena cava.

MATERIALS AND METHODS

Gianturco stents were placed in 39 patients with malignant obstruction of the superior (n = 16) or inferior (n = 23) vena cava. Thirteen patients with obstruction of the superior vena cava received radiation therapy and/or chemotherapy at some time in their course of treatment. Computed tomographic (CT) scans were obtained in all patients. The authors analyzed treatment outcome with the location, length, and CT appearance of obstruction.

RESULTS

Venous congestive symptoms disappeared after stent placement in 35 patients and remained in four. Symptoms did not recur during 1-13-month follow-up in 32 of the 35 patients in whom the symptoms disappeared. Nonfatal complications were observed in nine patients. Results of multivariate analysis showed that the outcome of stent placement is best predicted by the appearance of obstructions on CT scans irrespective of the location and length of the lesions.

CONCLUSION

Good results can be expected from placement of Gianturco stents except when CT shows the obstruction to be totally enveloped by tumor.

[Spatial and temporal alteration of the dual supply of the hepatic circulation with transient occlusion of the hepatic veins: spiral volumetric CT during arterial portography and arteriography]

To elucidate the contribution of hepatic veins to the blood flow of liver, CT arterial portography and/or arteriography was performed in eight patients having hepatocellular carcinoma with transient occlusion of the hepatic vein and eight without occlusion. In each patient with occlusion of the hepatic vein, CT showed a well-demarcated fan-shaped area of low density during arterial portography and increased density during arteriography in the corresponding area. Hepatic vein occlusion could result in the pooling of arterial blood in the liver parenchyma. Transient segmental hepatic venous occlusion might improve the results of transcatheter arterial infusion and transcatheter arterial embolization for liver tumors.

Acute effects of exercise on muscle MRI in peripheral arterial occlusive disease

The midcalf muscles of eight patients who had peripheral arterial occlusive disease were evaluated by exercise MRI before and after bypass surgery or percutaneous transluminal angioplasty. MRI showed a high intensity of these muscles, especially the posterior muscles, after exercise in all patients before intervention. The mean T2 relaxation time was maximal immediately after exercise (tibialis anterior, T2 = 30.8 ms; soleus, T2 = 36.2 ms; gastrocnemius, T2 = 32.8 ms) and then gradually decreased to the preexercise level. The difference in the T2 relaxation time of the soleus between immediately after exercise and at rest was smaller along with improvement of ankle pressure indices (API) after successful intervention (mean T2 difference: 4.91 and 0.72 ms (p < .001); mean API: 0.54 and 0.86 (p < .001) before and after intervention, respectively). The mean resting midcalf T2 relaxation time was significantly higher after intervention (tibialis anterior, T2 = 28.4 and 29.5 ms (p < .05); soleus, T2 = 31.4 and 32.9 ms (p < .05); gastrocnemius, T2 = 29.5 and 31.1 ms (p < .01) before and after intervention, respectively). T2 relaxation time may be a useful quantitative parameter in peripheral arterial occlusive disease as well as in other muscle studies.

Cardiac implications of the morning surge in blood pressure in elderly hypertensive patients: relation to arising time

Although morning surge in blood pressure has been shown to be associated with the occurrence of myocardial ischemic events and stroke, few studies have been done regarding its pathogenesis, probably because of a lack of method for the quantitative assessment of awakening time. We conducted an echocardiographic study and ambulatory blood pressure monitoring in 23 elderly hypertensive patients to evaluate the relationship between the hypertensive cardiac change and morning surge in blood pressure. Of note was that the time of arising from bed was assessed quantitatively by an activetracer equipped with an internal acceleration sensor to monitor the physical activity. The change in systolic blood pressure after arising from bed was correlated significantly with the left ventricular mass index (r = 0.51, P < .02) and the A/E ratio, which represents the diastolic function (r = 0.70, P < .01). In contrast, the change in systolic blood pressure before rising from bed was not correlated with any echocardiographic parameters. We conclude that the magnitude of morning surge in blood pressure after arising from bed was related with the severity of hypertensive target organ damage.

Effect of perindopril on 24-hour blood pressure levels and hemodynamic responses to physical and mental stress in elderly hypertensive patients

This study assessed the effects of an angiotensin-converting enzyme (ACE) inhibitor, perindopril, on the 24-hour blood pressure (BP) profile and hemodynamic responses to isometric exercise and mental stress in elderly hypertensive patients. We performed ambulatory BP monitorings and echocardiographic studies during hand-grip exercises and a mental stress test before and after the 10-week administration of perindopril in 11 elderly patients (mean age, 71.8 years). Office BP was significantly decreased by perindopril treatment. Both daytime and nighttime systolic BP decreased significantly without any change in circadian pattern (P < 0.05). Daytime diastolic BP was also significantly decreased by perindopril (P < 0.05); nighttime diastolic pressure was decreased, but this result was not statistically significant. The reduction in 24-hour BP was associated with a decreased left ventricular end-systolic dimension (P < 0.01) and an increased fractional shortening (P < 0.01), suggesting reduced afterload due to arterial dilatation. The left ventricular mass index was not changed by perindopril therapy, and neither were systolic and diastolic BP responses to the handgrip exercises. The increases in systolic BP during mental stress was augmented after perindopril therapy, although systolic BP during mental stress after treatment was significantly lower than before treatment (P < 0.05). These results indicate that perindopril is effective in reducing ambulatory 24-hour BP levels and is associated with improved systolic function caused by dilatation of resistance vessels.

[Effect of warm bathing on short-term and 24-hour blood pressure in bedridden elderly patients]

The effects of the bathing on short-term and ciracadian blood pressure (BP) in bedridden elderly patients were investigated in 10 bedridden patients (4 male: 6 female) living in a community home. The mean age of the subjects was 78.7 years old and causes of bedridden status were cerebrovascular disease in 9 and spinal damage in one. To study the short-term hemodynamic effect of bathing, BP and pulse rate were measured every 2 minutes from 10 minutes before bathing to 14 minutes after. Blood samples were collected before and after bathing for measurements of plasma catecholamine and plasma renin activity. To study the effect of warm bathing on circadian, BP, ambulatory BP was non-invasively monitored every 15 minutes for 24 hours on days with and without bathing. In the short-term phase, BP temporally elevated when washing the body outside the bathtub accompanied with a decline soaking in warm water (38 degrees C). Plasma catecholamine did not change after warm bathing. In the study of circadian change of BP, systolic BP on days of warm bathing remained at a lower level for 12 hours after bathing compared to days without bathing. In conclusion, hypotensive effects after bathing were prolonged in the bedridden elderly patients.

The efficacy of monatepil, a new calcium antagonist, in the treatment of essential hypertension

A multicenter, open-label trial in Japan examined the efficacy, safety, and optimal dose of monatepil (AJ-2615) as monotherapy and in combination therapy with angiotensin-converting enzyme (ACE) inhibitors or beta-blockers. Patients with essential hypertension who had never been treated or had been refractory to conventional antihypertensive agents were enrolled in the trial. During a 4-week control period patients assigned to monotherapy received placebo and those assigned to combination therapy received an ACE inhibitor or beta-blocker and placebo. Patients with systolic blood pressure (BP) > or = 160 mm Hg and diastolic BP > or = 95 mm Hg at the end of the control period were enrolled in the study. The initial dose of monatepil was 30 mg/day in monotherapy and 15 mg/day in combination therapy; the daily dose was titrated to 60 mg/day according to the antihypertensive response. The treatment period was 8 to 12 weeks. Blood pressure decreased from 168 +/- 8/100 +/- 6 to 142 +/- 9/85 +/- 7 mm Hg (SD) with monatepil monotherapy, from 171 +/- 11/102 +/- 6 to 141 +/- 9/84 +/- 6 mm Hg in combination with ACE inhibitors, and from 175 +/- 13/102 +/- 7 to 153 +/- 21/91 +/- 9 mm Hg in combination with beta-blockers (P < .001). When patients in whom mean BP decreased by > or = 13 mm Hg were defined as responders, the response rate was 80.4%, 78.1%, and 51.6% in the respective groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of elderly hypertensives in Japan: National Intervention Cooperative Study in Elderly Hypertensives. The National Intervention Cooperative Study Group

PREVALENCE OF HYPERTENSION IN ELDERLY JAPANESE PATIENTS: Data collected from post-mortem information at the Tokyo Metropolitan Geriatric Hospital showed that the overall prevalence of hypertension in Japanese patients aged over 60 years was 53%; one-third of these elderly hypertensives had isolated systolic hypertension. Isolated systolic and systolodiastolic hypertension were each associated with a similar degree of increased atherosclerosis and cardiovascular complications. In a placebo-controlled study antihypertensive treatment produced a reduction in withdrawal from treatment in elderly patients with mild hypertension. INTERIM TRIAL RESULTS: Some interim results have been obtained from a new trial which is currently under way in Japan, the National Intervention Cooperative Study for the Treatment of Elderly Hypertensives, a long-term study comparing the effects of a calcium antagonist (nicardipine) and a thiazide diuretic (trichlormethiazide) on cardiovascular complications in elderly patients with mild to moderate hypertension.

CT and MRI in detection of intrahepatic portosystemic shunts in patients with liver cirrhosis

OBJECTIVE

Our goal was to determine the prevalence and anatomic location of intrahepatic portosystemic shunts (IPSs) in patients with hepatic cirrhosis as shown by CT and MRI.

MATERIALS AND METHODS

We retrospectively reviewed CT and MR scans of 33 cirrhotic patients who had IPSs. In addition, two series of 100 consecutive CT or MR were reviewed to determine the prevalence of IPSs and the percentage of intrahepatic and extrahepatic paraumbilical veins.

RESULTS

Intrahepatic portosystemic shunts were divided into three groups according to the intrahepatic course: paraumbilical shunt between the left portal vein and the paraumbilical vein anterior to the liver (n = 29); inferior vena caval shunt between the posterior branch of the right portal vein and the inferior vena cava (n = 2); and miscellaneous (n = 2). Shunts of the paraumbilical type ran through the medial (n = 23), lateral (n = 3), or both medial and lateral (n = 3) segments of the left lobe of the liver. Twenty-five patients had one shunt, and four had more than one. Six cases were also associated with extrahepatic paraumbilical veins.

CONCLUSION

Intrahepatic portosystemic shunts, especially the paraumbilical type, were not infrequently visualized in patients with hepatic cirrhosis.

Improved detection of small insulinomas with intravenous dynamic CT

OBJECTIVE

To evaluate the usefulness of intravenous dynamic CT in demonstrating angiographically negative insulinomas.

MATERIALS AND METHODS

Two patients with endocrinologic evidence of insulinoma were examined with intravenous bolus-dynamic CT.

RESULTS

Angiographically negative insulinomas as small as 5-7 mm were demonstrated unequivocally as enhancing nodules.

CONCLUSION

Intravenous dynamic CT using larger amounts of contrast material can improve detection of small (< 1.0 cm) insulinomas.

[Examinations to detect left atrial thrombus and blood coagulation test analyses in aged patients with atrial fibrillation]

To screen for risk of embolism, we investigated the association between the presence of left atrial (LA) thrombus by transesophageal echocardiography (TEE) and blood coagulation tests, including thrombin-antithrombin III complex (TAT), plasminogen activator inhibitor 1 (PAI-1), plasmin-alpha 2-plasmin inhibitor complex (PIC), D-dimer, tissue plasminogen activator (tPA), free tPA, tPA.PAI-1 complex, prothrombin fragment 1+2 and fibrin degradation product E (FDP-E) in 40 patients with atrial fibrillation (Af) (13 males, 27 females, mean age 76 +/- 8 yrs). Blood coagulation tests were performed in 21 control subjects with sinus rhythm (12 males, 9 females, mean age 75 +/- 4 yrs). LA thrombi were detected in the appendage of 8 patients and in the atrium of 6 patients. Severe atherosclerotic plaque with thrombi in the thoracic aorta were detected in 6 patients without LA thrombi. FDP-E, D-dimer and PIC increased significantly in patients with LA thrombi or aortic plaque in comparison with controls with sinus rhythm. In patients with Af, 25 of them (group A) has more than 4 abnormal coagulation values out of 9 tests and 15 of them (group B) had abnormalities in less than 3 tests. LA thrombi or aortic plaque were detected in 18 patients in group A and 2 patients in group B (72% vs 13%, p < 0.01). In 4 of 6 patients with large LA thrombi, the thrombi were resolved after administration of warfarin. Before administration of warfarin, tPA, PA-1 and tPA.PA-1 complex levels were higher in the two patients whose thrombi did not resolve.(ABSTRACT TRUNCATED AT 250 WORDS)

Age-related changes in cytoskeletal components of the BDF1 mouse Sertoli cell

Age-related changes in mouse Sertoli cell cytoskeletal components (F-actin, vimentin and cytokeratin) were investigated by light and transmission electron microscopy and immunofluorescence using BDF1 mice from 3-33 months of age. In old mice (30 and 33 months of age), the testicular seminiferous epithelia were extremely thin, containing scarce round spermatids and spermatocytes with no elongated spermatids. In these epithelia, the Sertoli cells had lost their polarity and had become flattened. F-actin was detectable at the junction between adjoining Sertoli cells and around the spermatid head in young mice. In old mice, F-actin was distributed at the junction between adjacent Sertoli cells, around the spermatid head, and at the luminal side of the Sertoli cell cytoplasm. Vimentin was detected around the Sertoli cell nucleus and extended into the Sertoli cell trunk towards the tubular lumen in young mice. In old mice testes, however, vimentin was recognized around the Sertoli cell nucleus, but not in the Sertoli cell trunk. Additionally, sheet-like reactions of vimentin, running parallel to the basement membrane, were detected near the luminal surface. Although cytokeratin was not detected in the Sertoli cells of mice until 27 months of age, it was obvious in the extremely thin seminiferous epithelia of older mice. Cytokeratin was randomly distributed within the Sertoli cell cytoplasm. In these Sertoli cells, the expression of vimentin was concurrently detected. Detection of cytokeratin in the extremely thin seminiferous epithelia is one of the most characteristic phenomena of age-related testicular changes in Sertoli cells of older mice.

Ovarian dysgerminoma: MR and CT appearance

OBJECTIVE

We determined the MR and CT appearance of ovarian dysgerminoma and correlated our findings with the pathologic features.

MATERIALS AND METHODS

CT and MR findings of three patients with ovarian dysgerminoma were retrospectively reviewed and compared with the pathologic findings.

RESULTS

The tumors were divided into lobules by septa that were hypointense or isointense on T2-weighted imaging and showed marked enhancement on Gd-diethylene triamine pentaacetic acid enhanced T1-weighted imaging and contrast-enhanced CT. These septa corresponded to fibrovascular bundles at histologic examination.

CONCLUSION

CT and MR findings characteristic of fibrovascular septa within solid ovarian masses should raise the possibility of dysgerminomas.

Metastatic tumors in irregular fatty liver mimicking focal sparing

Two cases of hepatic metastatic tumor occurring in irregular fatty liver are reported. These metastatic tumors appeared as irregularly shaped hyperdense areas and were difficult to distinguish from focally spared areas of irregular fatty liver. Even if areas of focal sparing are irregular in shape, hepatic tumors should be carefully ruled out in patients at high risk for liver tumors.

Is white coat hypertension innocent? Structure and function of the heart in the elderly

To evaluate the morphological and functional characteristics of the heart in elderly patients with white coat hypertension, we performed an echocardiographic study in 67 elderly individuals older than 60 years: 17 patients with white coat hypertension, 34 patients with true hypertension, and 16 normotensive control subjects. White coat hypertension was defined as a mean 24-hour ambulatory systolic blood pressure of less than 140 mm Hg associated with office hypertension. Cardiac responses to an isometric handgrip exercise test were used to evaluate left ventricular functional reserve. Left atrial dimension and left ventricular mass index were significantly greater in the white coat hypertension group than in the normotension group (P < .05) but were similar to values in the true hypertension group. Left ventricular diastolic function, expressed by peak late-early filling ratio of diastolic mitral flow, showed increasing impairment in the order of the normotension, white coat hypertension, and true hypertension groups (analysis of variance, P < .05); the ratio in the white coat hypertension group tended to be higher than that in the normotension group (unpaired t test, P = .054). The relation between fractional shortening and end-systolic stress did not shift downward after handgrip exercise in the white coat hypertension group, indicating that functional reserve in the left ventricle was maintained. Thus, patients with white coat hypertension had a moderately increased left atrial dimension and left ventricular mass in association with a tendency for disturbed diastolic function, although systolic functional reserve remained the same. These findings suggest that white coat hypertension in the elderly may not be innocent.

[The evaluation of lung cancers hidden by the mediastinal and hilar shadows on the plain chest film]

We retrospectively evaluated the plain chest frontal radiographs in four cases in which the lung cancers were quite difficult to observe prospectively on plain chest frontal radiographs in spite of the relatively large size of tumors (over 3 cm in diameter). Three of four cases were central-type lung cancers, two squamous cell carcinomas and one adenosquamous cell carcinoma. Since there was no associated atelectasis or obstructive pneumonia in these cases, wall thickening and indistinctness of the lumen of the central bronchi were the significant findings for diagnosis. One case proven to be adenocarcinoma was located in the periphery of S6. A focally increased radiopacity behind the descending pulmonary artery was the only finding to pointed out. Since tumors were not demonstrated directly in the aerated lungs, the condition of the central bronchi as well as the degree radiopacity of the pulmonary artery should be carefully interpreted.

Systemic arterial supply to normal basal segments of left lower lobe: CT findings

OBJECTIVE

The purpose of this study was to evaluate the usefulness of CT in making a diagnosis of systemic arterial supply to normal basal segments of the left lower lobe.

MATERIALS AND METHODS

We retrospectively reviewed chest radiography (three cases), CT (three cases), and angiography (two cases).

RESULTS

An anomalous systemic artery arising from the descending aorta was shown as a retrocardiac density on posteroanterior radiography and as a nodular density behind the heart on lateral radiography. Contrast enhanced CT revealed the vascular nature of the density adjacent to the descending aorta. Dynamic CT in one patient demonstrated that the nodular density was composed of an anomalous systemic artery and a prominent inferior pulmonary vein. High-resolution CT showed the interlobar artery distal to the origin of the superior segmental artery to be absent. The bronchial system of the left basal segments was normal as was the pulmonary parenchyma on CT.

CONCLUSION

Characteristic CT findings consist of absence of the interlobar artery distal to the origin of the superior segmental artery and origination of an anomalous artery from the descending aorta that gives off branches to normal left basal segments. With a constellation of these CT findings, angiography would be obviated for definite diagnosis of this anomaly.

[Long-term follow-up study after permanent pacemaker implantation in patients aged 60 years or over with sick sinus syndrome]

Ninety-five patients aged 60 years or over with a permanent pacemaker implanted for sick sinus syndrome were divided into two groups: 32 patients with physiological pacing (group P) and 63 patients with ventricular pacing (group V). The mean follow-up period was 45.0 +/- 36.6 months in group P and 50.3 +/- 37.8 months in group V. Paroxysmal atrial fibrillation (Af) occurred in 28% of group P and 71% of group V (p < 0.05). The incidence of stable Af was also lower in group P than in group V (9% vs. 30%, p < 0.05). None of group P with only bradyarrhythmia had stable Af. However, 6 of 21 patients (29%) in group V with bradyarrhythmia showed stable Af. There was no significant difference in stable Af between group P with bradycardia-tachycardia syndrome (BTS) and group V with BTS (19% vs. 31%). A lower incidence of embolic events was also observed in group P (3% vs. 25%, p < 0.05). Nine of 16 patients with embolic events in group V died of complications following embolism (8 patients; cerebral embolism, one patients: renal and superior mesenteric arterial embolism). The survival rates at 5 and 10 years were 80% and 69%, respectively, for group P and 56% and 33% for group V (p < 0.01). Thus, with regard to permanent pacing for patients with sick sinus syndrome, physiological pacing should be selected for control of morbidity and total mortality.

Age-related morphological changes in the testis of the BDF1 mouse

Age-related morphological changes in the testis of the BDF1 mouse were studied by light and transmission electron microscopy. No apparent changes were detected until 12 months of age. After 18 months of age, vacuoles firstly appeared in the seminiferous epithelium. These vacuoles were gradually increased in number and showed a tendency to cluster with each other in accordance with age. While, germ cells were decreased in number. The sloughing of germ cells caused a thin seminiferous epithelium. In the tubule with a thin epithelium, spermatogenesis was severely interrupted. After 30 months of age, extremely thin seminiferous epithelia were observed. In these epithelia, most of spermatids and spermatocytes disappeared, and most of Sertoli cells lost their polarity to be flattened. On the other hand, in the interstitial region, PAS-positive cells (mononuclear phagocytes) tended to increase in number after 24 months of age. PAS-positive extracellular matrix newly appeared at 27 months of age. In the cytoplasm of Leydig cells, a whorl of sER was frequently found. Degeneration of testes proceeded with age. The regressive tubules occupied only 2.2% at 18 months of age, but extended to 63.0% at 33 months.

[The relation between blood pressure variation and daily physical activity in early morning surge in blood pressure]

Morning rise in blood pressure (morning surge; MS) has been shown to be associated with the occurrence of myocardial ischemic events and stroke. This study aimed to elucidate the incidence and the mechanism of MS in hypertensive patients (HT). We monitored ambulatory blood pressure (BP) and physical activity in 68 untreated HTs using TM2421 (A & D Co. Ltd.) and ACTIVETRACER (GMS Ltd.) for detection of MS. MS was defined as a rise in BP > 50 mmHg (90% tile of 35 normotensives) during early morning (4:00 to 9:00 A.M.) compared with the lowest basal BP at night. MS was seen in 41 patients (52.6%) and was classified into two groups; MS1: BP rose steeply after waking up (27 patients) and MS2: BP started to rise gradually during sleep (14 patients). The mean age of MS1 was significantly higher than that of MS2 (72 vs. 62 years, p < 0.01). BP reached its basal value earlier in MS2 than in MS1 at night though the basal BP values were comparable between the two groups. Mean 24-hour BP and physical activity were similar between the two groups, though significantly higher incidence of cases with a correlation between SBP and activity was seen in MS1. In conclusion, there are two types of MS, the mechanisms of which may differ. MS occurring immediately after waking up was more common in older HTs, and possibly was related to augmented arousal response in BP, while MS beginning gradually during sleep was more common in younger HTs and was characterized by reaching basal BP earlier at night.

[Age and gender difference in circadian rhythm in blood pressure]

In order to evaluate the effect of gender and aging on the diurnal rhythm of blood pressure (BP), we performed ambulatory BP monitoring in 267 normotensive volunteers (mean age +/- SD 52.1 +/- 24.6 years, range 16-93 years, 114 men, 153 women). Ambulatory 24-hour BP was recorded every 30 minutes with an oscillometric method by ABPM630 (Nippon-Kolin, Japan). Circadian rhythm was determined by fitting the 24-hour cosine function curve. Subjects were divided into three age groups, consisting of the Y group (age < 30), M group (age > or = 30 but < 60), and E group (age > or = 60). Highest normal values of the 24-hour mean BP (90 percentile of the values) were 126/75 mmHg in the Y group, 126/76 mmHg in the M group, and 154/85 mmHg in the E group in men. They were 117/67 mmHg, 125/77 mmHg 151/79 mmHg respectively in women. The MESOR of SBP increased with age in women, though it was significantly higher only in the E group among men. The amplitude of SBP decreased with age significantly only in men. The acrophase of SBP shifted to an earlier time of day with aging in both men and women. The trends in the circadian rhythm of DBP with age were similar to those of SBP. In conclusion, the circadian rhythm of blood pressure varies with gender and aging. The 24-hour blood pressure values should be considered with evaluating sex-age matched reference values.

Improved CT fat detection in small kidney angiomyolipomas using thin sections and single voxel measurements

OBJECTIVE AND METHODS

Seven echogenic renal masses < 1.0 cm in size were studied by CT to make the diagnosis of angiomyolipoma by identifying the presence of fat.

RESULTS

In four of six lesions, initial 5 mm section CT failed to detect fat, although repeat 3 and/or 1.5 mm section CT was successful in demonstrating fat. In one patient who underwent 3 and 1.5 mm section CT, attenuation values of four voxels were low enough to indicate the presence of fat only on the 1.5 mm sections.

CONCLUSION

Measuring single voxel values in the hypoattenuating areas on nonenhanced thin (3 or 1.5 mm) sections is essential for CT diagnosis of small (< 1.0 cm) renal angiomyolipomas.

Effects of alpha,beta-blocker, arotinolol chloride, on 24-h blood pressure--difference between elderly and younger hypertensive patients

To assess the effect of age on the circadian blood pressure (BP) after an alpha,beta-adrenergic blocker, the ambulatory BP was measured before and after arotinolol chloride administration in nine younger (mean age 49.1 years) and 14 older (72.1 years) patients with essential hypertension. After a 4-week control period, arotinolol chloride was administered twice daily (08:00 and 20:00 hours) for 8 weeks and the ambulatory BP was measured non-invasively at the end of the control and treatment period. Arotinolol significantly reduced the daytime systolic BP from 152.3 to 140.9 mmHg (P < 0.05) and night-time systolic BP from 137.3 to 122.3 mmHg (P < 0.01) in the younger hypertensive patients. In contrast, in the older group, the night-time systolic BP did not show a significant change, although the daytime systolic BP was significantly reduced from 155.0 to 142.2 mmHg (P < 0.02). Diastolic BP in both groups was significantly reduced by arotinolol during the day and night. Night-time reduction of BP was significantly less in the older group (-8.6 vs -15.1 mmHg for the systolic pressure P < 0.01; -5.8 vs -9.8 mmHg for the diastolic pressure P < 0.01).

Food restriction suppresses an age-dependent increase in the exhalation rate of pentane from rats: a longitudinal study

Longitudinal age changes in the exhalation rates of ethane and pentane, which are used as the indices of in vivo lipid peroxidation, from rats under ad libitum feeding and food restriction were measured. The exhalation rate of ethane or pentane from old, ad libitum-fed rats is higher than that of the corresponding hydrocarbon from young, ad libitum-fed rats, as reported previously. There is no difference between the exhalation rates of each hydrocarbon from young, ad libitum-fed and food-restricted rats. However, the exhalation rate of pentane from old, food-restricted rats is significantly lower than that from old, ad libitum-fed rats, while the exhalation rate of pentane from old, food-restricted rats tends to be lower than that from old, ad libitum-fed rats. In addition, the exhalation rate of pentane from old, food-restricted rats is equivalent to that from young, ad libitum-fed rats. These results are consistent with the views that in vivo lipid peroxidation in rats is increased during aging, and that the age-dependent increase in in vivo lipid peroxidation is suppressed by food restriction.

The relationship between ambulatory blood pressure and physical activity in young and older shiftworkers. A quantitative assessment of physical activity using a microcomputer with acceleration sensor

We studied the relationship between physical activity and ambulatory blood pressure (BP) in young and older shiftworkers by simultaneous recordings of activity, blood pressure and pulse rate (PR). Activity was assessed using Activetracer, a self-contained microcomputer with an acceleration sensor, attached to a waist belt. Ambulatory BP was monitored every 30 minutes for 48 hours with a TM2421. Three types of hemodynamic responses were noted in relation to the physical activity. The balance type, in which both BP and PR increase with physical activity, was observed in 5 of 10 young cases (50%) but only in 1 of 7 older cases (14.3%). The BP response type, in which the BP increases with no change in the PR, was observed in 6 of the 7 older (86%) but only in 3 cases in the young group (30%). The PR response type, in which only the PR increase correlated with activity, was observed in 2 cases in the young group (20%) and none in the older group. The difference in systolic BP between periods of activity and rest in the older shiftworker was significantly larger than that in the young group (15.9 +/- 6.4 vs. 5.9 +/- 6.6 mmHg, p < .01), although no significant difference was observed in diastolic BP. In contrast, the increase in pulse rate after movement was significantly higher in the young group (4.4 +/- 4.0 vs. 9.0 +/- 4.8 bpm, p < .05). Thus, the fluctuation of the systolic BP was more dependent on physical activity in the older group, whereas PR variations correlated with the physical activity in the young group.

[An elderly case of supernormal conduction in the posterior division of the left bundle branch]

An electrophysiologic study was performed in a 95-year-old man with bifascicular block (right bundle branch block and left anterior hemiblock). During sinus rhythm (AA interval = 980 ms), every sinus beat was conducted to the ventricle. The AH interval was 130 ms and HV interval was 50 ms. A programmed premature atrial stimulation was performed after 8 paced beats at a slightly shorter cycle length than the sinus cycle length (900 ms). As the atrial coupling interval was shortened, the H1H2 interval also shortened. At an H1H2 interval of 680 ms the premature atrial beat was blocked distal to the recording site of the His potential. The block persisted up to an H1H2 interval of 560 ms. AV conduction resumed paradoxically when the H1H2 interval was further shortened to intervals lasting 540-490 ms. During this period the H2V2 interval was 50 ms. At still shorter H1H2 intervals, H2 was again blocked. The H2V2 intervals during this phase of improved conduction were unchanged compared with those of other conducted beats. Therefore normalization due to the gap phenomenon could be ruled out, and the improved conduction could be explained by a phenomenon of supernormal conduction in the posterior division of left bundle branch.

Circadian blood pressure change after carteolol chloride in younger and older hypertensive patients

To determine whether there is an age-related difference in circadian blood pressure changes after administration of a beta-adrenergic blocker, 24-hour ambulatory blood pressure was measured before and after administration of long-acting carteolol, a beta-blocker with intrinsic sympathomimetic activity, in 9 younger and 13 older hypertensive patients. Ambulatory blood pressure was measured noninvasively using an ambulatory blood pressure monitor every 30 minutes for 24 hours before and 8 weeks after a once-daily administration of 15 mg of carteolol. Systolic and diastolic blood pressure in the office significantly decreased in both groups after 8 weeks of carteolol treatment. The whole-day systolic and diastolic blood pressures also fell significantly after carteolol treatment in both groups. Carteolol reduced systolic and diastolic blood pressures during the day in both groups. However, no reduction was observed in nighttime systolic blood pressure in either group, although nighttime diastolic blood pressure tended to decrease in the younger group (P = 0.051). The pulse rate during the night significantly increased in both groups, although no change was observed during the day in either group. We conclude that the antihypertensive effect of carteolol on the circadian blood pressure pattern in younger and older hypertensive patients is comparable. Carteolol reduced only daytime blood pressure while hardly affecting the nighttime blood pressure in both groups.

[A case of primary systemic amyloidosis with skeletal muscle atrophy and congestive heart failure]

A 77-year-old male had been noticing progressive weakness of the legs for three years. By the age of 75 he had difficulty in climbing stairs. On admission, serum level of CPK was moderately high. There were weakness and atrophy of the proximal muscles. Deep tendon reflexes were depressed. Sensation was normal. The electromyogram and the biopsy of the femoral quadriceps muscles showed nonspecific changes. In 1989, he developed difficulty in walking and had congestive heart failure. On the second admission, moist rales were heard over the chest, and pitting edema was present in the lower extremities. The chest roentgenogram showed a cardiothoracic ratio of 63% and bilateral pleural effusion. The electrocardiogram showed atrial flutter with 2:1 conduction, QS in V1-3, rS in V4, and ST depression and T inversion in V5,6. The echocardiogram revealed a thick left ventricular wall and impaired left ventricular contraction (EF 22%). Macroglossia, hepatosplenomegaly and renal dysfunction were not noted. Congestive heart failure progressed and he suddenly died of ventricular tachycardia in December 1989. At autopsy, skeletal muscle fibers varied in size and showed fiber splitting. A cellular infiltration was observed in the stroma. Amyloid deposit was positively stained with Congo red. The heart weight was 570 g with marked left ventricular hypertrophy and moderate bilateral atrial dilatation. In both atria and ventricles, extensive amyloid deposition was found around myocardial fibers as well as in perivascular spaces. Amyloid was present also in the liver, the kidneys, the gastrointestinal tracts, and the other organs.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence, rate of correct clinical diagnosis and mortality of cancer in 4,894 elderly autopsy cases]

The prevalence, rate of correct clinical diagnosis and mortality of cancer were analyzed in 4,894 consecutive autopsies at the Tokyo Metropolitan Geriatric Hospital from 1972 to 1990. average age and standard deviation of patients was 78.1 +/- 9.1 years. Cancer was found in 45.5% of patients of 60 years and over, and in 49.1% in men and 41.9% in women (p < 0.001). Cancer prevalence decreased with advance in age; 50.0% in the sixties, 47.9% in the seventies, 43.2% in the eighties and 39.3% in the nineties and over. Multiple cancer was found in approximately 12% of patients of 70 years and over. The top three cancer incidences were gastric cancer, 15.0%, lung cancer, 10.7% and colon cancer, 5.9% in both genders. In men, prostate cancer was next common, followed in orderly hepatic cancer, esophageal cancer, gall bladder-bile duct cancer, pancreas cancer, renal cancer and urinary bladder cancer. In women, the following order of frequency was gall bladder-bile duct cancer, uterus cancer, pancreas cancer, hepatic cancer, breast cancer, thyroid cancer, esophageal cancer, renal cancer and urinary bladder cancer. The prevalence of gastric cancer, lung cancer, hepatic cancer and esophageal cancer was significantly higher in men, while that of gall bladder-bile duct cancer was higher in women. The age-related tendencies varied among cancers of different organs. Gastric cancer increased up to the sixties in men and up to the seventies in women and leveled off after those ages. Lung cancer revealed peak prevalence in the sixties and seventies and decreased after the age of eighty.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of finger blood pressure measurement devices for home-use]

We evaluated the accuracy of two types of finger blood pressure (BP) measurement devices for home-use (EW276 H, NATIONAL Ltd. and HEM 804F, OMRON Ltd.) by comparing BP values with upper-arm BP measured with a standard mercury column sphygmomanometer in 28 elderly subjects (13 Hypertensives and 15 normotensives). The correlation coefficient of systolic BP value and that obtained by each method was R2 = 0.5 for EW 276H and R2 = 0.6 for HEM 804F. The higher the systolic BP, the greater was the difference between the upper-arm and finger BP values. The magnitude of the difference between finger and upper-arm values for systolic BP did not correlate with pulse wave velocity. An underestimation of the finger BP device in systolic BP was 23.8 mmHg in hypertensives and 7.6 mmHg in normotensives for the EW 276H, and 15.3 and 3.5 mmHg, respectively for the HEM 804F. This study demonstrated a large difference between the finger BP value measured with the home-use devices and upper-arm BP value measured with a standard mercury sphygmonanometer in elderly hypertensive patients. The difference may be due not only to atherosclerotic change, but also to methodological factors related to finger BP measurement.

[Changes in blood pressure and pulse rate during visit to a doctor's office]

Changes in blood pressure (BP) and pulse rate were measured during visits to a doctor's office by means of an non-invasive ambulatory BP monitoring device in 47 elderly hypertensive patients (mean age 73.0 years). Systolic BP increased from 140.5/85.4 mmHg to 157.9/85.7 mmHg immediately after entering the doctor's office and tended to return to the previous level at 5 minutes after entering although diastolic BP did not change during the visit. Pulse rate also increased slightly, but significantly on entering the office. The difference in BP between 25 minute before and just after entering an office was +17.4 mmHg in systolic. -0.1 mmHg in diastolic. If an increment in systolic BP more than 10 mmHg was defined as positive for white coat effect, they were observed in 59.6%. The frequency of white coat hypertension was 46.7% in the age of sixties, 65.2% in seventies and 66.7% in eighties but there was no significant difference among 3 groups. There was a tendency for white coat hypertensions to be more frequent in men compared than in women (p = 0.07).

Possible regulation of caffeine-induced intracellular Ca2+ mobilization by intracellular free Na+

To gain some understanding of the regulatory mechanism involved in caffeine-induced Ca2+ release in adrenal chromaffin cells, we took advantage of the paradoxical observation that removal of divalent cations potentiated the secretory response to caffeine. We measured the concentration of cytosolic free Ca2+ ([Ca]in) in isolated cat chromaffin cells, by fura-2 microfluorometry, to see whether there was any correlation between the secretory response and the rise in [Ca]in. The caffeine-induced [Ca]in rise and catecholamine secretion were increased by treatment of cells with a divalent cation-deficient solution. These potentiated responses were strongly inhibited either by pretreatment with ryanodine, by the reduction of the external Na+ concentration, or by the addition of Ca2+ channel blockers. Removal of divalent cations caused a large rise in the cytosolic free Na+ concentration ([Na]in), which was measured using SBFI microfluorometry. This rise in [Na]in was reduced either by adding Ca2+ channel blockers or by reducing the external Na+ concentration. These results show a good correlation between caffeine-induced Ca2+ release and [Na]in at the time of stimulation, suggesting that caffeine-induced Ca2+ release is regulated by [Na]in.

[A study on 24-hour ambulatory blood pressure in normotensive elderly, living in a local home for the aged]

Ambulatory blood pressure (BP) was non-invasively monitored in 124 normotensive elderly, living in an old people's home at the annual health examination. Cases were divided into 41 cases < 75 years (group A, mean age 70.6) and 83 cases > or = 75 years (group B, 82.7) for analysis of the office BP and 24-hour BP. Whole-day systolic BP in group B was significantly higher than those in the group A (p < 0.02) although no significant differences were observed in diastolic BP and pulse rate. Separated analysis of whole-day BP into daytime and nighttime revealed that the nighttime systolic BP in the group B was significantly higher than those in group A (132.2 +/- 17.4% vs. 123.8 +/- 18.6 mmHg, p < 0.02) whereas no significant difference was observed in day-time systolic BP between two groups (136.6 +/- 14.9 vs. 132.1 +/- 14.4 mmHg, n.s.). The day-night difference in systolic BP tended to be less in group B than in group A (4.5 +/- 11.6 vs. 8.2 +/- 12.2 mmHg, p < 0.10). The prevalence of non-dippers, who had a higher nighttime systolic BP than daytime systolic BP were 24.4% of the group A and 30.1% of the group B. It was concluded that systolic BP during the nighttime increased with the ageing process after age 60, although that during daytime did not change.

Lifetime data analysis of disease and aging by the Weibull probability distribution

We applied the Weibull distribution to the life-table and age-patterns of diseases in Japan. The life-table follows a composite Weibull distribution composed of initial failure and two stage wear-out failure periods. The extension of lifespan during the past century is manifested as increases in the scale parameters in all three periods and the shape parameters in the wear-out periods with female predominancy. The shape parameters of diseases show time-independent sex-dependent specific values. When consistent changes are observed, such as increases in the shape parameters of tuberculosis and pneumonia, legitimate causes such as prevention and repair at the societal and medical level are present. Cancer and arteriosclerosis share a common range of shape parameters suggesting analogous underlying biological processes. An analysis of the epidemiology of human aging and disease by the Weibull distribution discloses intrinsic properties of man as a biological organization as well as a societal presence.

[Age-related incidence of spontaneous tumors in SPF C57BL/6 and BDF1 mice]

Incidence of spontaneous tumors in C57BL/6 NCrj (CR), C5BL/6 CrSlc (SL) and B 6 Crj x DBA/2 NCrj F1 (BD) mice, which were reared under a barrier system and died natural death, were examined. Cohorts of mice in 200 to 300 each were purchased at 4 weeks of age and raised under SPF conditions. A large portion of the mice were used for various experiments between 3 and 30 months old while not a small number died before use and were autopsied. Median survival periods of the female and male were estimated at 697 and 680 days for CR, 764 and 806 days for SL and 866 and 929 days for BD, respectively. Incidence of spontaneous neoplastic lesions in the autopsied animals were 77.4% and 79.2% of 535 female and 590 male CR, 69.7% and 55.1% of 502 female and 463 male SL, and 75.8% and 78.0% of 298 female and 346 male BD, respectively. In CR, histiocytic sarcoma was the most predominant tumor, accounting for 72.1% of all tumors. In SL, malignant lymphoma was the most prevailing, forming 62.3%, and, in male BD, hepatocellular carcinoma was the most frequent, accounting for 41.8% of all tumors.

[Age-related non-tumorous lesions in SPF C57BL/6 mice with special reference to amyloidosis]

Non-tumorous pathological changes in C57BL/6 CrSlc mice, which were reared under a barrier system and died spontaneously, were examined. At 3 months intervals 125 to 209 mice were purchased at 4 weeks of age and raised for the supply of aged animals. A large portion of the mice were used for various experiments between 3 and 30 months of age, while not a small number died spontaneously and were autopsied. The major non-neoplastic lesion was amyloidosis, with incidence of 55.5% and 74.4% for the autopsied female and male, respectively. The organs involved were the liver, kidneys, spleen, adrenal glands, ileum, heart and lungs. Skin ulceration and its scar, cerebral vascular calcification, glomerulosclerosis and sepsis in both sexes, distension of the seminal vesicles in males, fibroblast growth of the adrenal glands in females were commonly found. Incidence of spontaneous neoplastic lesions was 69.7% and 55.1% for the female and male, respectively.